Vineville Internal Medicine LLC
Organization Active NPI Internal Medicine Physician · Macon, GA
NPI 1396955431 · NPPES record last updated Aug 20, 2014
Key facts
- NPI
- 1396955431
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 049552 (GA)
- Legal business name
- VINEVILLE INTERNAL MEDICINE LLC
- Practice address
- 3448 Vineville Ave
Macon, GA 31204-1867 - Phone
- (478) 405-0045
- Fax
- (478) 405-0054
- NPI assigned
- May 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Katie B Andrews
- Title
- Administration
- Phone
- (478) 405-0045
Practitioners 34
-
Katie Aldridge, NP
-
Melissa Butts, FNP-C
-
Erin Faulkner Caves, NP-C
-
Ashley J Dykes, FNP-C
-
Shannon Slocumb Ethridge, FNP-C
-
Jenna Rubin Franz, FNP
-
Tammy H. Hughes, MSN
-
Kimberly Crump Johnson, NP-C
-
Jennifer Nicole Barron Lee, MSN, APRN, FNP-C
-
Haylee Elizabeth Duck Martin, FNP-C
-
Jarrett Daniel Mitchell, FNP-C
-
Sarah Rose Mitchum, FNP-C
-
Kristen Nicole Selph, FNP-C
-
Mary Bell Hancock Vaughn, M.D.
-
Kayla Sue Whitley, DNP, APRN, FNP-C
-
Jennifer Nicole Woodall, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1005138 | Vineville Internal Medicine | Compliance | Dec 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060223000410 | GA | Part B Supplier - Clinic/Group Practice | 0941281711 |
Receives reassigned benefits from 34 practitioners Practice locations: Macon, GA |
National Provider Directory
Locations
147 James St
Gray, GA 31032
Phone (478) 405-0045
3448 Vineville Ave
Macon, GA 31204
Phone (478) 405-0045
1024 Keith Dr
Perry, GA 31069
Phone (478) 987-3445
506 Osigian Blvd
Warner Robins, GA 31088
506 Osigian Blvd
Ste 3
Warner Robins, GA 31088
506 Osigian Blvd
Ste 4
Warner Robins, GA 31088
Phone (478) 405-0045
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | 049552 | GA | Yes |
Addresses
Primary practice location
3448 Vineville Ave
Macon, GA 31204-1867
Mailing address
3448 Vineville Ave
Macon, GA 31204-1867
Phone (478) 405-0045
Other providers in Macon, GA
- Village Podiatry Group LLC
- Village Podiatry Group, LLC
- Village Podiatry Group, LLC.
- Lauren Elizabeth Villo
- Henry Rodriguez Viloria
- Clara H Vinh
- Pierre K Vinh
- Ashley Hendley Vinson
- Felicia Michelle Vinson
- Roselily Viray
All providers in Macon, GA · Internal Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.